How much more are DELAWARE ACA enrollees really paying this year due to Trump/GOP policies?

Thu, 05/28/2026 - 10:36am

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Today I'm looking at DELAWARE:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by raw metal level:

On the surface, besides Delaware seeing ~8,200 fewer people sign up for coverage out of the gate, this makes it look like the average Actuarial Value (AV) dropped 3.2 points. If so, this would mean that average plan quality also dropped for the ~44,000 residents who did sign up for coverage.

However, this is misleading since a huge chunk of ACA enrollees are generally low-income enough to be eligible for Cost Sharing Reduction (CSR) assistance, which boosts Silver plans up to Platinum levels of AV for most CSR enrollees. When I adjust for that, the weighted average AV increases in both years...but the gap between the two also increases to 4.6 points:

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (which, as I stated in the original post, can vary widely by carrier and year, so this should be considered a very broad average only), which looks like so:

In Delaware, the ~44,000 residents who did sign up for ACA exchange coverage saw their net premiums jump by 48% on average...along with seeing a ~54% increase in out of pocket expenses.

Combined, on average, that's a 50% increase in net healthcare costs, from ~$4,700 apiece last year to over $7,100 per enrollee in 2026.

In addition, based on KFF's net data, average deductibles also jumped by 50% as well to nearly $4,400 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.